Exercise-induced hypotension in a male population. Criteria, causes, and prognosis.

Abstract

The objective of this study was to demonstrate the causes, optimal definition, and predictive value of exercise-induced hypotension occurring during treadmill testing. This study included all patients referred for clinical reasons to the Long Beach Veterans Administration Medical Center treadmill laboratory and then followed for a 2-year period for cardiac events. The population consisted of 2,036 patients who underwent testing from April 4, 1984, to May 7, 1987, 131 of whom exhibited exercise-induced hypotension (6.4%). We found that exerciseinduced hypotension is usually related to myocardial ischemia or myocardial infarction, is best defined as a drop in systolic blood pressure during exercise below the standing preexercise value, and indicates a significantly increased risk for cardiac events

Exercise Standards for Testing and Training

“…21 In most studies, exercise-induced hypotension in association with other measures of ischemia predicts a poor prognosis, with a positive predictive value of 50% for left main or triple-vessel disease. 22 Exercise-induced hypotension is also associated with cardiac complications during exercise testing (for example, serious arrhythmias), seems to be alleviated by coronary artery bypass grafting (CABG), and can occur in subjects with CAD, valvular heart disease, or cardiomyopathy. Occasionally, subjects without clinically significant heart disease will exhibit exercise-induced hypotension during exercise related to dehydration, antihypertensive therapy, or prolonged strenuous exercise.…”

Exaggerated exercise blood pressure response and risk of stroke in patients referred for stress testing

“…To ensure comprehensive follow-up data, 1113 patients who did not belong to the geographic area of reference of our hospital were excluded. Given that beta-blocker therapy may blunt an EESBPR [16], 1218 patients who received betablockers within 48 h before the tests were also excluded; lastly, because of the well-known association of an exercise hypotensive or flat blood pressure response with poorer outcome [17], 950 patients in whom systolic blood pressure (SBP) failed to increase with exercise above the baseline values were also excluded. The remaining 10,047 patients constituted European Journal of Internal Medicine 25 (2014) 533-537 our sample.…”

Coronary Artery Disease

“…The finding often indicates severe heart failure or multivessel CAD. 7 Other causes of hypotension include fixed cardiac output, which occurs with stenotic valvular disease and hypertrophic cardiomyopathy, volume depletion, and certain drugs such as vasodilators. The test should be stopped if hypotension occurs.…”